Provider Demographics
NPI:1780621862
Name:FISCUS, GEORGINA L (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:L
Last Name:FISCUS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:GEORGINA
Other - Middle Name:L
Other - Last Name:TRUEBLOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 W. UNION ST.
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602
Mailing Address - Country:US
Mailing Address - Phone:520-586-0800
Mailing Address - Fax:520-586-0116
Practice Address - Street 1:590 S. OCOTILLO AVE.
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6405
Practice Address - Country:US
Practice Address - Phone:800-586-7080
Practice Address - Fax:520-586-3161
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW106351041C0700X
AZLCSW-106351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ83262Medicare ID - Type UnspecifiedNORIDIAN
AZ83262Medicare UPIN